Cancer Presentation (Main)

8/8/2019 Cancer Presentation (Main)

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PHARM.D 4th year(POST BACCULAUREATE).


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Cancer is a term used for diseases in which

abnormal cells divide without control and are

able to invade other tissues. Cancer cells canspread to other parts of the body through the

blood and lymph systems.


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Cancerous cells develop from healthy cells in a complex

process called transformation.

The first step in the process is initiation :

In which a change cells genetic material

(in the DNA and some times in the chromosome

structure) primes the cell to become cancerous.

o Cancer can occur by carcinogens include(chemicals ,tobacco , viruses , radiation and sunlight) . A genetic

flaw in a cell may make it more susceptible. Even

chronic physical irritations may make a cell more

susceptible to carcinogens.


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The second and final step in the development of

cancer is called promotion.

Unlike carcinogens promoters does not cause cancer

by them selves. But some carcinogens sufficientlypowerful to be able to cause cancer without the need

of promoters.


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1) Leukemia's and lymphomas are cancers of bloodand blood forming tissues.

2) Carcinomas are cancers of epithelial cells which are

the cells cover the surface of body ,hormones andglands.

Eg: skin ,lungs ,stomach, breast, prostate and

thyroid gland cancer.

Typically,carcinomas occur more often in older than

in younger people.


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3

) Sarcomas are cancers of mesodermal cells ,whichare the cells that form muscles and connective

tissue .

Examples of sarcomas are

leiomyosarcoma (cancer of smooth muscle that is

found in the wall of digestive organs) and

osteosarcoma (bone cancer)

4) Central nervous system cancers - cancers thatbegin in the tissues of the brain and spinal cord.

.


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Chemotherapy utilizes chemicals that interferewith the cell division process - damaging

proteins or DNA - so that cancer cells will

commit suicide. These treatments target anyrapidly dividing cells (not necessarily just

cancer cells), but normal cells usually can

recover from any chemical-induced damage

while cancer cells cannot.


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Chemotherapy is generally used to treat cancer that

has spread or metastasized because the medicines

travel throughout the entire body. It is a necessarytreatment for some forms of leukemia and

lymphoma.

Chemotherapy treatment occurs in cycles so the

body has time to heal between doses.

However, there are still common side effects such as

hair loss, nausea, fatigue, and vomiting. Combination

therapies often include multiple types ofchemotherapy or chemotherapy combined with other

treatment options.


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Examples Mechanism of action Side Effects

Alkylating agents

Cyclophosphamide

Chlorambucil

Melphalan

Form chemical bond with

DNA, causing breaks in DNA

and errors in replication ofDNA

Suppress bone marrow

Injure lining of stomach

Cause hair lossMay decrease fertility

Suppress the immune system

May cause leukemia

Antimetabolites

Methotrexate

Cytarabine

6- Mercaptopurine

5-Fluorouracil

Block synthesis of DNASame as for alkylating agents

Do not increase risk of

leukemia


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Antimitotics

Vincristine

Paclitaxel

Vinorelbine

Docetaxel

Block division of cancer cells

Same as for alkylating agents

Also can cause nerve damage

Do not cause leukemia

Topoisomerase inhibitors

Doxorubicin

Irinotecan

Prevent DNA synthesis and

repair through blockage of

enzymes called

topoisomerases


Doxorubicin

can cause heart damage

Platinum derivatives

Cisplatin

Carboplatin

Form bonds with DNA causing

breaks


Also can cause nerve and

kidney damage, hearing loss


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Hormonal therapies

Tamoxifen Blocks estrogen action (in

breast cancer)

Can cause endometrial cancer,

blood clots, hot flashes

Aromatase inhibitors

Bicalutamide

Anastrozole

Exemestane

Letrozole

Blocks androgen action (inprostate cancer)

Block estrogen formation

Can cause erectile dysfunction(impotence) and diarrhea

Can cause bone loss

(osteoporosis) and menopausal

symptoms

Signaling inhibitors

Imatinib

Blocks signal for cell division in

chronic myelocytic leukemia

Can cause abnormal liver

function test results and fluid

retention


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Gefitinib

Erlotinib

Blocks epidermal growth factor

receptor

Can cause rash, diarrh

Monoclonal antibodies

Rituximab

Trastuzumab

Gemtuzumab

ozogamicin

Induces cell death through

binding to cell surface receptor

on lymphocyte-derived tumors

Blocks growth factor receptor on

breast cancer cells

Contains a specific antibody that

attaches to a receptor found onleukemic cells and then delivers

a toxic dose of its

chemotherapeutic component to

the leukemic cells

Can cause allergic reaction

Can cause heart failure

Contains a specific antibody that

attaches to a receptor found onleukemic cells and then delivers

a toxic dose of its

chemotherapeutic component to

the leukemic cells

Biologic response modifiers

Interferon-alpha Unknown

Can cause fever, chills, bone

marrow suppression, thyroid


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Differentiating agents

Tretinoin

Arsenic trioxide

Induces differentiation and

death of leukemic cells

Induces differentiation and

death of leukemic cells

Can cause severe difficulty

with breathing (respiratory

distress)

Causes abnormal heart

rhythms and a rash

Agents that block blood

vessel formation

(antiangiogenic agents)

Bevacizumab

Serafinib

Sunitinib

Blocks vascular endothelial

growth factor (VEGF)

BlockVEGF receptor

Can cause high blood

pressure, protein loss in

urine, bleeding, clotting,

intestinal perforation.

Can cause high blood

pressure and protein loss inurine


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Most cancers are/become refractory to treatment by a single agent,Most cancers are/become refractory to treatment by a single agent,

combinations of anticancer drugs are often used. The following rules applycombinations of anticancer drugs are often used. The following rules apply

to combining drugs in cancer chemotherapy:to combining drugs in cancer chemotherapy:

1.1. The drugs each must have some activity against the cancer.The drugs each must have some activity against the cancer.

2.2. The drugs should act via different mechanisms.The drugs should act via different mechanisms.

3.3. The drugs should have minimal overlapping toxicity.The drugs should have minimal overlapping toxicity.

4.4. Cellular resistance to each drug should occur by different mechanisms.Cellular resistance to each drug should occur by different mechanisms.

The first drug combination, made famous by Dr. V. DeVita and others atThe first drug combination, made famous by Dr. V. DeVita and others at

NIH, is called MOPP (Mechlorethamine, oncovonin, procarbazine, andNIH, is called MOPP (Mechlorethamine, oncovonin, procarbazine, and

prednisone). MOPP is a curative treatment for Hodgkin's disease and itsprednisone). MOPP is a curative treatment for Hodgkin's disease and its

development was a major step forwarddevelopment was a major step forward


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ABVD: Doxorubicin (adriamycin), bleomycin, vinblastine,

dacarbazine Used for: Hodgkins disease

CHOP: Cyclophosphamide, doxorubicin (hydroxydaunorubicin),vincristine (oncovin), prednisone Used for: Non-Hodgkin'slymphoma

CMF: Cyclophosphamide, methotrexate, fluorouracil Used forBreast carcinoma

IFL: Irinotecan, fluorouracil, leucovorin

Used for: Colorectal carcinoma with or without oxaliplatin

MOPP: Mechlorethamine, vincristine (oncovin), procarbazine,prednisone

Used for: Hodgkins disease

PEB: Cisplatin (platinum), etoposide, bleomycin Used forTesticularcarcinoma


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Carcinoma of lung:

Cisplatin + taxane, or cisplatin + etoposide, or cisplatin +irinotecan

Carcinoma of breast: Hormonal therapy (Tamoxifen or Anastrozole)

FAC: Fluorouracil, doxorubicin (adriamycin),cyclophosphamide

FEC: Fluorouracil, epirubicin, cyclophosphamide

CMF: Cyclophosphamide, methotrexate, fluorouracil

Carcinoma of prostate:

Hormonal therapy:GnRH agonist plus androgenantagonist


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Carcinoma of colon:

IFL: Irinotecan, fluorouracil, leucovorin with orwithout oxaliplatin

In trials: cisplatin, irinotecan, and a taxane

Pedicatric Leukemia

Acute lymphocytic leukemia. Induction:vincristine plusprednisone.

Remission maintenance:mercaptopurine, methotrexate,and cyclophosphamide in various combinations.

Acute myelocytic and myelomonocytic leukemia.Combination chemotherapy: cytarabine and mitoxantroneor daunorubicin or idarubicin


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SHORTTERM

Fever

Nausea

Infusional reactions

Oral complications

Diarrhea

Anemia

Neuropathy

Alopecia

Rash, Extravasation

Emotional


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Long-term :

Cardiac Secondary Malignancies

Fatigue

Neuropathy

Arthropathy


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http://www.cancer.gov/cancertopics/what-is-

cancer

www.medicalnewstoday.com/info/cancer.../w

hatiscancer

www.merckmanualonline.com .


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Cancer Presentation (Main)

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